HomeMy WebLinkAboutPermit Plumbing 1993-10-8
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RESIDENTIAL
PERMIT APPLICATION
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SPRINGFIELD
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JOB NUMBER
Inspections: 726.3769
Office: 726.3759
LOCATION OF PROPOSED WORK: 556 ~ \
ASSESSORS MAP: \ () OQ ~3 YJ --
225 Fifth Street
Springfield, Oregon 97477
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tj TAX LOT: (t) \?1CfJ
LOT:
BLOCK:
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SUBDIVISION:
OWNER '\< \ (\ \La\.- ~.tJ") _, \,{\bY\. V)l,L
ADDRE~' 5\0 \..C) . WJ
CITY: r1 Y)~ ?-L '
DESCRIBE WOR"'- \_)hili],
STATE:
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NEW
REMODEL
ADDITION
DEMOLISH
OT HER
PHONE:
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ZIP'
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CONST.
ADDRESS C\J)j CONTRACTOR "I
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EXPIRES PHONE
q S'~ f\Ablo.QL8
GENERA'
PLUMBING:
MECHANICAL:
ELECTRICAL:
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QUAD AREA: ~~~ - OFFICE USE -
LAND USE: \\~() FLOOD PLAIN:
" OF BLDGS: -~ 11 OF UNITS: 0rv ZONING CODE: LD~
OCCY GROUP: ''R~ CONSTR, TYPE: 11 OF BDRMS: 5
" OF STORI ES: l HEAT SOURCE: FG SECONDARY HEAT: -..
tf~ 7~ 1 f6)CJ io'
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WATER HEATER: RANGE' SQUARE FOOTAGE:
To request an inspection, you must call 726.3769, This Is a 24 hour recording, All inspections requested before 7:00 a.m, will be
made the same working day, Inspections requested after 7:00 a,m. will be made the following work day,
o Temporary Electric
D Site Inspection - To be made
after excavation, but prior to
setting forms.
o
Underslab Plumbing/ Electrical/
Mechanical - Prior to cover.
o Footing - After trenches are
excavated,
o
Masonry - Steel location, bond
beams, grouting.
o
Foundation - After forms are
erected but prior to concrete
placement.
o
Underground Plumbing - Prior
to filling trencll,
o
Underlloor Plumbing/ Mechanical
- Prior to Insulation or decking,
o
Post and Beam - Prior to floor
Insulation or decl<ing.
,
o Floor Insulation - Prior to
decki ng,
,
o
Sanitary Sewer - Prior to filling
trencll.
o
Storm Sewer - Prior to filling
trencll,
O Water line - Prior to~ filling
trench.
o Rough Plumbing - Prior to
cover,
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REQUIRED INSPECTIONS
o .Rough Mechanical - Prior to
cove~ '
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Rough Electrical - Prior to
cover,
o Electrical Service - Must t)e
approved to obtai n permanent
electrical power.
o
Fireplace - Prior to facing
materials and framing Insp,
o
Framing - Prior to cover,
o Wall/Ceiling Insulation - Prior to
cover,
o Drywall :- Prior to taping,
o Wood Stove - After installation.
o Insert - After fireplace approval
and installation of unit.
o
Curbcut & Approach - After
(orms are erected but prior to
placement of concrete,
o Sidewalk & Driveway - After
excavation Is complete, forms
and sub.base material in placo,
\. 0 Fence - When completed,
o Street Trees - When all r!:q.~ired
trees are planted, " "
o
Final Plumbing ,..:.. When all
plumbing work Is complete.
o
Final Electrical - When all
electrical work is complete,
o
Final Mechanical - When all
mectlanical work Is complete.
o Final Building - When all
required inspections have been
approved and building Is
completed.
o Other
MOBILE HOME INSPECTIONS
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locking and Set.Up - When all
locking Is complete.
~IUmbing Conne~tions - When
ome has been connected to
waleI' and sewer.
!t7DElectrical Connection - When
f blocking, set-up, and plumbing
Inspections have been ap!?!oved
and the home is connectea to
t service, n~~
~ al - After all required
, spectlons are approved and
porches, skirting, decks, and
venting have been Installed,
Lot faces "
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Lot sq. fig.
Lot coverage
Topography
Total height
BUILDING PERMIT
ITEM SQ. FT,
Main
Garage
Carport
Total Value
BuUding Permit Fee
, ~ " t
State Surcharge . :
Total Fee
Lot Type
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IS THE PROPOSED WORK IN THE
HISTORICAL DISTRICT, OR ON
, THE HISTORICAL REGISTER?
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Interior
Corner
, ~'Panhandle
_ Cul-de-sac
X $/SQ, FT.
.
(A)
1
........
Setbacks
I P,L. HSE GAR ACC
IN
S
W
IE
=
VA LU E
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SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
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Residential Bath{s)
Sanitary Sewer
Water
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Storm Sewer
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
NO
FT.
FT,
FT,
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
NO
Wood Stove/Insert/Fireplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
MISCELLANEOUS PERMITS,
Mobile Home
State Issuance
State Surcharge
Sidewalk
Curbcut
Demolition
S~ate Surcharge
It
It
Total Miscellaneous Permits (E)
FEE
,
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1 ~:L CO
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l~_-~
}D5,dJ
~() .CD
o,~
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, 0, and E Combined)
~./ CO
L--7~.
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance,
" APPROVED:
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BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
. This permit is granted on the express condition that the said
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construction shall, in all respects, conform to the Ordinance
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adopted' by. the City of Spri[1gfield, i.ncluding the
Development Code, regulating the construc'tion and use of
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances,
Plan Check Fee:
Date Paid:
Receipt Number:
Received By:
. I' ~
Plans Reviewed By
Date
Systems Development Charge is due 'on all undeveloped
properties within tile City limits which are being improved.
ADDITIONAL COMMENTS
By signature, I state and agree, that I have carefully examined
the completed application and do hereby certify that all
information hereon is true and correct, and I further certify
that any and all work performed shall be done in accordance
with the Ordinances of the City of Springfield, and the Laws
of the State of Oregon pertaining to the work described
herein, and thaI NO OCCUPANCY will be made of any
structurewithoul permission of the Building Safety Division,
I further certify lIlat only contractors and employees who
are in compliance wilh ORS 701.055 will be used on this
project.
I further agree to ensure that all required inspections are
requested at the proper time, that each address is readable
from the street, that the permit card Is located at the front
of the property, and the approved set of plans will remain
on the Si~e at 'mes d~~.dnstruc~oy
Signature 0/ ~uU ~
- ''';'/, ./
Date/~-?-9~
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VALIDATION:
\\)~~
.R.R3 c0
/41f- .
RECEIPT NUMB'lR,
DATE PAID I()
AMOUNT REC
RECEIVED BY
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Issued b.y:
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UJ).. ), Date:
Permit No:
Address:
FOR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT, CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701,055(4), requires residential construction permit
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued, This state-
ment is required for residential building, electrical, mechanical, and plumbing
, permits, Licensed Architect and Engineer applicants, exempt from registration
under ORS 701,010(7), need not submit this statement This statement will be
filed with the permit.
Fill in the applicable blanks,' and initial boxes 1 and 2, and either box 3A or 3B:
1. C.9
2. I I, I understancj that I must register as a construction contractor if the structure is sold
\ ,or offered for sale before or, upon completion. '
3. A.~ My general contractor is \<..D~l)
, r ,Contractor registration number~ \ a~ "-
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I own, reside in, or will reside in the completed structure.
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I will instruct my general contractor that all subcontractors who work on the struc~
ture must be registered with the Construction 'Contractors Board,
OR
3. B.I
I I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors'registered with the Construc-
, tion Contractors Board'. If I change my mind and do hire a general contractor, I will
contract with a contractor who is registeredwith the Construction Contractors Board
and I will immediately notify the office issuing this building permit of the name of
the contractor.
I hereby certify that the above information is correct and that I have read and understand
the Information Notice to Property Owners about Construction Responsibilities on the
reverse side of this form.
/()'r{ -5
Date
CCNSTRUCTION CONTRACTORS BOAR'P
0244J 8/91
WHITE COPY TO ISSUING AGENCY PERMIT'FILE
PINK COPY TO APPLICANT
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INFORMtON NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
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NOTE:; . This Information Notice to: Property Owners About Construction Responsibilities
was developed by the Con~truction Contractors Board in accordance with ORS 701.055(5),
passed by the 1989 Oregpn legislature. .
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If you are acting as your own contractor to construct a new home or make a substantial improvement to an
existing structure, you can prevent many problems by being aware of the following responsibilities and areas
of concern.
[EMPLOYER RIESPONS~~~lU1~ES:
If you hire persons not register~d with the Construction Contrac~ors Board to do labor in constructing or assisting
in the construction or improver:nent of a residential $tructure, you will, in most instances, be ruled to be an
"employer" and the people you hire will be "employees". As the employer, you must comply with the following:
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Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at
the time employees are paid. You will be liable for the tax payments ,even if you don't actually withhold the
tax from your employees. For more information, call the Oregon Department of Revenue at 378-3390.
Unemployment Insurance Tax: As'an employer, 'you are required to pay a'tax for unemploym'ent insurance
purposes on the wages of all employees. For more information, call the Oregon Employment Division DHR
at 378-3224.
Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation
Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers'
compensation insurance, you may be subject to penalties and wi~1 be liable, fOi all claim costs if one of your
employees is injured on the job. For more j'hformation, ,call the Workers' Compensation Division DIF'at 373-7434.
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U.S. Internal Revenue Service: P:s an employer, YOl,J must withhold federal income tax from employees' wages.
You will be liable for the tax payment even if you didn't actually withhold the tax. For more information, call
the Internal Revenue Service at 221-3960.
OT~IE~ ~~$[!>>Q)U\!J$~[81~lUl~reS ~~[j) t!\~re~s Ou: rcONCIE~U\fl:
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Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet
code requirements 'that may be brought tovour attention through inspections.
Liability and Property Damage Insurance: Contact your insurance agent to see if you have adequate insurance
coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punc-
tures, fire, or work that must be re-done.
Time to Supervise Employees: ,Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work
of rough-in and finish trades, and to notify building officials at the appropriate times so t~ey can perform
the required inspections. .
If you have additional questions, write to:
Construction Contractors Board
700 Summer. St. NEt Suite 300
Salem, OR 97310-0151
Phone 503-378-4621
, 0244J 10/24/89
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SeGFIELD
DEVELOPMENT SERVICES DEPARTMENT
225 FIFTH STREET
SPRINGFIELD. OR 97477
(503) 726-3753
FAX (503) 726-3689
MOBILE HOME AND MANUFACTURED HOME AGREEMENT
UNITS TO BE PLACED IN A PARK
As required b~ the~Cityof Springfield Development Code and/or the State of
Oregon, I understand and agree, as shown by my signature on this form, that with
th~ ,~~~l~fAt~e attashed~ermits for a hom~ tO,be located at ,
~-)t~..f) \.AJ' LDw. ..ftPl } , ' , Spnngfleld, Oregon, Cl ty Job Number
C1~~/~~<r ~Wili meet or exceed the below listed minimum setbacks.
Home Setbacks
10 feet from a park building
20 feet from any public street
5 feet from any rear space line or interior space line
5 feet from the edge of a park street
2 feet from the interior edge of a park sidewalk
.
Accessory Structure Setbacks
10 feet from a park building
20 feet from any public street
5 feet from the edge of a park street
2 feet from the interior edge of a park sidewalk
3 feet from an interior space line or rear space line
I further state, by my signature below, that I have been provided with the
following information:
Manufactured Home Blocking Requirements
Minimum Requirements for Permanent Steps
- Electrical Connection
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igna ture ~ /
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